WASHINGTON — Cheers erupted on the House floor Sunday night as the vote count hit 216, the magic number of representatives needed to pass the Senate’s health care reform bill through the House. Later this week, President Obama will sign into law the largest single reform of the nation’s health care system since the creation of Medicare in 1965.
The final tally was 219 in favor to 212 against, with all Republicans present voting no. As expected, Democrats Keith Ellison, Betty McCollum, Jim Oberstar and Tim Walz voted for the bill, while Democrat Collin Peterson joined Republicans John Kline, Michele Bachmann and Erik Paulsen in opposing it. About an hour later, the House passed a reconciliation bill including “fixes” to the just-passed health care legislation with one additional yes vote.
“This isn’t radical reform, but it is major reform,” President Obama said. “This legislation will not fix everything that ails our health care system. But it moves us decisively in the right direction. This is what change looks like.”
Advocates agreed with Obama that the bill isn’t perfect. Ellison and McCollum wanted a public option (they still haven’t given up on that), while Oberstar and Walz held out until almost the bitter end in an effort to remedy geographic disparities in Medicare rates.
“Health care’s always an evolutionary process, and we’ll have to continue to make adjustments, but tonight is a benchmark, landmark, watershed achievement,” Oberstar said.
“Tonight’s enormous,” Ellison agreed. “It’s up there with the civil rights bill, it’s up there with Medicare, it’s up there with Social Security. It will be part of the economic/social/political framework of America within five years — it will be how we live.”
A reconciliation bill containing “fixes” to the approved health care bill now heads to the Senate, where Republicans said they plan to raise a host of procedural objections to the bill’s applicability under budget reconciliation rules. Meanwhile in the House, Kline and Bachmann pledged to fight to repeal the legislation starting as soon as it’s signed.
“Today’s votes were a loss for the American people, but the battle is far from over,” Kline said in a statement following the vote. “We must now begin working to undo the government takeover of health care and replace it with meaningful reforms that will finally bring down health care costs.”
Jockeying for votes
Until the final days, Democrats weren’t entirely sure they had Oberstar and Walz on board. Both had said they were leaning yes, but held out over Medicare rates (Oberstar’s spokesman admitted as much, comparing his boss’ stance to a poker player who knows when to hold ’em). They decided on Saturday to finally commit, but the story of how they became “Yes” votes actually starts about nine months ago, in June of 2009.
House Speaker Nancy Pelosi was leaving a Democratic caucus meeting just as McCollum rose to speak about an issue she said was costing Minnesota hospitals millions — the geography-based Medicare reimbursement formula that pays medical providers in Texas, California and South Florida sometimes twice as much for the same procedures as high-quality providers like the Mayo Clinic in Rochester, despite Mayo having better patient outcomes.
Pelosi stopped and listened. When McCollum finished, and a number of other Midwestern lawmakers finished agreeing with her, Pelosi committed to addressing the Medicare formula in this health care legislation. Soon after, the Congressional Quality Care Coalition was formed.
At 3 a.m. Saturday, that same coalition would come to an agreement with the White House and lawmakers from high-cost states like Texas, California and New York on geographic disparity, including $800 million over the next three years for doctor and hospital payments in states including Minnesota. A conference on geographic disparity will be held later this year, in anticipation of the formula being rejiggered by 2012. By 2014, a quality-of-care metric will be added, paying providers more for achieving better patient outcomes at a lower cost.
“People have been trying to do that for decades,” McCollum said, triumphant. Shortly after that deal was announced Saturday, Walz and Oberstar announced their support.
None of the Republicans were really gettable, Democrats said, and neither was Peterson. Asked if she had lobbied Peterson to flip his no vote to a yes, McCollum replied “Nope, Collin made it pretty clear a while ago that he was not going to vote for health reform.”
“Collin’s a very strong-willed person,” Ellison agreed. “I don’t think it would be much use of my time to try and get him to do something he doesn’t want to do. I don’t even bring it up with him, because I guarantee you he has nine reasons he can cite at the drop of a hat why he’s not doing it, so he’s not doing it, and that’s why I’m glad we have 216 votes to do it.”
Peterson issued a statement following the vote citing his reasons why he opposed the measure. “In my judgment, while these bills deliver some good things they miss the mark on the most important things and will not deliver as promised,” he said, saying the bill doesn’t cut health care costs and would only cover 37 percent of the uninsured in the 7th District.
“This legislation avoided making the critical reforms we really need in order to strengthen our rural health care system and by doing so it punts these problems into the future where it’s likely that they’ll be even more difficult and more expensive to solve.”
Senate leaders say they have at least 52 votes to pass the reconciliation package, and most tallies included Amy Klobuchar and Al Franken among the likely yeses. Consideration of the bill will begin likely Wednesday, with the goal of voting before the week ends.
Should the reconciliation measure pass the legion of parliamentary challenges it’ll face, it will go to the president for his signature before Easter.
Ellison said he still plans to raise the public option in an effort to get that passed. “Once we’ve got started, why stop?” he asked.
If the goal is to do that this year, someone in the Senate will likely have to tack it on to the reconciliation bill the House just passed, as one can only do one reconciliation bill each budget year. While there are more than 40 votes in the Senate for a public option, it’s unlikely that anything will be added to the bill for fear of having to re-pass it in the House. Indeed, fears of adding anything and upsetting the proverbial apple cart prompted the House Rules Committee to reject every single amendment brought to it for inclusion in the health care package voted on Sunday night.
One of those rejected amendments was a Paulsen measure that would have removed a $20 billion (over 10 years) fee on medical devices, saying the levy is likely to result in manufacturers who are currently based in his 3rd District packing up shop and heading to other countries where they don’t face that tax burden.
Paulsen said he’ll keep working on that, but expects the House to pivot to other issues, including financial reform and the deficit.
“I think we’re going to move on to a number of other issues this year, but clearly it seems like the most defining issues center around the levels of spending and borrowing and national debt,” Paulsen said. “I don’t think people are going to forget this vote, they’re not going to forget the budget votes they’re going to be paying attention to Washington living within its means which we’re not doing.”
Outside the House chamber is the Speaker’s Lobby, an ornate room of portraits and chandeliers where members used to take their smoke breaks. Now that smoking is forbidden, members are forced to use a balcony just off the lobby. In front of that balcony Sunday was a crowd of a few-hundred Tea Party protesters who cheered as Republicans emerged and booed as Democrats came out for fresh air.
Bachmann and Kline took many trips to the balcony today, each taking their turn clapping, cheering and pumping their fists. That riled up the crowd, which responded with chants of “Kill the Bill!” and “USA, USA, USA!” That was perhaps a bit nicer than the pitch-perfect “Na na na na, na na na na, hey hey hey, goodbye” that many Democrats got.
Those Tea Partiers were clearly thinking election — indeed it’s impossible to think about a controversial piece of legislation in an election year without thinking of the upcoming midterms. Minnesota doesn’t have any truly toss-up districts this fall, but it does have two incumbents that opposite party strategists are set on ousting.
For Democrats, that’s Bachmann. For Republicans, it’s Walz. And make no mistake; this vote will be used time and time again against each of them.
Americans United for Change will announce at 9 a.m. Central that they’re going up with a $100,000 TV ad buy hitting Bachmann for her vote.
“Just like Social Security or Medicare or civil rights, those like Congresswoman Bachmann who voted to protect the status quo will find themselves on the wrong side of history,” said Tom McMahon, acting director of Americans United for Change. “Michele Bachmann made a different kind of history by voting to deny giving Minnesotans access to the same kind of insurance she enjoys very much as members of Congress. If it’s good enough for her, shouldn’t it be good enough for the people of Minnesota?”
Bachmann said the “people will decide” who they reward for whatever votes they’ve cast, but predicted surprisingly “big, big losses” for Democrats this fall.
The Democrat with the biggest target on his back is Walz. State GOP chairman Tony Sutton issued a statement calling Sunday night’s House vote an “historic disaster,” saying Walz “will lose his seat for his decision to ram this deeply unpopular and partisan bill down the throats of the American people.”
Tom Erickson, spokesman for the National Republican Congressional Committee, echoed those words, saying, “Walz can expect that the upcoming campaign will be the fight of his life.”